Provider Demographics
NPI:1477750107
Name:GANDY, KATHARINE RAE (DC)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:RAE
Last Name:GANDY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ELM GROVE RD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2546
Mailing Address - Country:US
Mailing Address - Phone:414-881-6634
Mailing Address - Fax:
Practice Address - Street 1:500 ELM GROVE RD
Practice Address - Street 2:SUITE 325
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2546
Practice Address - Country:US
Practice Address - Phone:262-782-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4319-012111N00000X
TX10204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor